Thursday, 28 February 2008

Hamsters with CS gas

It's bad enough being called animal names but to be made to look like Punch & Judy is pushing it...a policeman's lot as they watch crowds during the New Year festivities (photo taken in on 1st January).

Thirteen emergency calls – two conveyed in the car, one cancelled on scene, one not required, one no trace and the rest required an ambulance.

Friday nights are killers, especially when they herald my long weekend of nights (I do four 12 hour stints in one tour of duty). At least this time I had company – I was asked to take someone out with me for the shift.

As usual, it didn’t take long for the first job to come in and I was off to help an unconscious 20 year-old who was lying somewhere in a small park. I left my alien torch in my other stab vest cover pocket, so I had no light to see by, apart from my pen torch, when we arrived and started looking for him. Luckily, his street mates were taking care of him and they waved me over. The patient was now conscious and I knew him; a young alcoholic from East Europe who had needed our attention several times in the past year.

He had been found unconscious and very cold – he was hypothermic when I checked. We walked him to the car and I decided to take him to hospital myself, rather than tie an ambulance up. To get to the car we had to jump down a three foot wall, so I warned my charge that it was coming but he didn’t jump – he fell. The landing, short as it was, twisted his knee, so now he had another problem and another reason to go to hospital. There wasn’t much I could have done to prevent him falling, he had been warned and I wasn’t going to carry him down. In his drunken, hypothermic state, he had completely misjudged the drop.

We got him to hospital and I booked him in – at least he would be warm and closer to pain relief for his injured limb.

Sometimes you look at someone and you completely miss the obvious because your judgment is obscured by a preconception. A 19 year-old female who collapsed suddenly at work and whose manager was very concerned but also very helpful, had me and the crew on scene, treating her as an innocent young woman with an unknown problem. But she had that look about her and we all recognised it. She claimed that she felt ill and became unconscious without any explanation or cause. She denied drugs or alcohol and she said she had been eating properly. She didn’t have a virus and there was no food poisoning suspected. She was taken to hospital and supported as she walked to the ambulance. Every one of us displayed professional caring and sympathy.

What we didn’t know, but nevertheless suspected, was that she was a heroin addict and she had injected herself at work. She had collapsed in a quiet alley outside the bar that she worked in, which was suspicious, but her pinpoint pupils were the biggest clue and I asked her for confirmation that she hadn’t taken any drugs. She was a plausible liar. They all are but I think we were fooled by her innocent demeanour - more so than with the others.

Chronic Pain Disorder is a strange ‘disease’. My next patient, a 60 year-old man, collapsed in a tube station and the staff thought he was having a fit. When I examined him, however, he displayed signs and symptoms more akin to a stroke than epilepsy, although a seizure can go hand-in-hand with a neurological insult.

His behaviour was bizarre and it took me and the crew a little while to get him upstairs and into the ambulance because he claimed to be a CPD sufferer and that he had pain down one side of his body. When we got into the vehicle, I offered him pain relief and he initially refused but then he asked what I would give him. I told him morphine could be administered and suddenly his mind was changed; he would have some analgesia after all. I found this suspicious.

I cannulated him but he didn’t get any morphine – he got a flush of saline instead. He had already taken pain relief earlier on and, to be honest, I couldn’t work out his state of mind. None of us were quite sure if he was actually in pain (he only referenced it when asked about it) or had suffered a stroke (our FAST test was negative and his speech was fine) or was a mental health candidate. I suspected the latter.

I told him that he wasn’t getting any morphine and he was fine with that. His pain wasn’t so bad now anyway, apparently. Off he went to hospital and I returned to my car with my new friend Scott – my rideout companion for the shift.

One drunk on a bus is one drunk on a bus too many, right? The next call was for FOUR non-responsive men on a bus, all sitting separately. When one person is out, I’ll go and deal with it, when two are out, things are looking tricky but when three or more are out, we go into a state of alert. I was told to stand-by at an RV, as was the ambulance. The bus was parked around a corner and all I was allowed to do was stand outside the car and look at it.

The HART team were sent for this, as they always are for a 1,2,3 type call and they cautiously entered the street where the bus was sitting. They didn’t have their space suits on – that would have been more over the top than this was.

The police arrived a few minutes after we did and they entered the street and got on the bus. A few seconds later I received an update that the police had immediately been attacked by the men who were currently being arrested. I was then told to go round and see if there were any casualties. Luckily, there weren’t. All of the men, bar one, were arrested for assault. This is why over-the-top precautions. Apparently, they were off their heads on crack cocaine.

A quick call to assist a crew with a heavy, drug overdosed patient next. He was on the fourth floor of a building with a narrow, winding staircase, which made for a very awkward lift and carry in the chair. He was unconscious, so it was no picnic, even for three of us.

I travelled a long way out of my area for a drunk on a bus, only to find the police walking her off when I got on scene. A completely unnecessary journey.

A very worried 69 year-old woman with chest pain which radiated to her left arm may have been suffering a heart attack. She had no definitive cardiac history but that didn’t rule it out and she was taken to hospital quickly.

Then a ride in my car for a 20 year-old female who had been hit over the head after an argument with a random guy in Soho. Her very drunk friend came with us and she began to suffer the full effects of her earlier binge. So much so, in fact, that she collapsed in front of her now bedbound mate in hospital. The girl in bed looked on as we struggled to lift her up while she thrashed and vomited onto the cubicle floor. Funny and sad at the same time.

Our next run was for a 27 year-old man who’d walked straight into a moving bus and sustained a fairly serious head injury. HEMS were activated and I was sent to assist the FRU on scene. The man was conscious but he had a large open wound on his forehead and because he was drunk, it was difficult to accurately assess his GCS.

As we packed him into the ambulance, the HEMS team (all six of them!) arrived but they didn’t stay long because the man wasn’t injured seriously enough to justify the need. They went instead to my next call; a man who’d just been stabbed in the chest at Trafalgar Square. When I arrived, he was already being worked on by the team, several crews and another FRU who’d also been brought in.

He lay on the street in a large pool of his own blood as his girlfriend (I presumed) screamed and yelled nearby. For Scott, this was a first – he hadn’t yet seen anything so traumatic and certainly not in such circumstances. He was quite rightly shocked at the violence (and result of it) we see. Welcome to the ambulance service.

I worked with the teams around me (all I needed to do was get some fluids up and running) and we got the teenager into the ambulance and rapidly to hospital. There’s no doubt that the efforts of the first arriving crew, who just happened to be in the right place at the right time and got this one as a running call, helped. Their actions would have made a huge difference until HEMS arrived.

Initially, I was sure the young man wouldn’t survive and it’s only now, as I write this, that I have discovered he is still hanging on to life. He shouldn’t be because his heart must have been penetrated by the knife that punctured his chest. He will probably never thank the crew who started saving his life, so I’ll do it here...thanks and well done!

There was no trace of the 19 year-old girl who was supposedly unconscious (? cause), so I called it a no-trace and went to my next call for a 78 year-old man with chest pain, a history of PE and a swollen ankle. He has had three bypasses, so I wasn’t surprised to see a less than healthy picture on his ECG. Another trip to hospital then but sooner or later, his body will give up the fight.

I must have been particularly wicked recently because there was no rest at all tonight. My last job took me to LAS HQ where a man had collapsed in front of the entrance. He was surrounded by police and ambulance officers and a crew joined me as I tried to make sense of what was wrong with him. We spent more than half an hour listening to him rant about his hatred of all things Irish and Scottish (which offended me, of course) and his love of all things English. He spun and twisted and thrashed on the ground. He was clearly out of his mind; either on MDMA, or something else...or he had just had a psychotic breakdown. How else could I explain his irrational loathing of the Celts?

In any case, cruel as it sounds, he was highly amusing at times. One of the cops tried to restrain his legs because he was very strong and seemed to have endless energy. At one point I felt he was going to dislocate my thumb after he grabbed it and held on during my second attempt at getting a BM (I really shouldn’t have bothered). I heard it click and there was a sharp pain as it popped back into place.

He looked down at the cop restraining him by the legs and said ‘F*ck off, you f**king hamster!’

This brought us all to tears because the police officer did look a bit like a hamster when you caught a certain angle of his head. Nobody would have noticed that about him without the aid of drugs or madness.

Eventually, he was cuffed and fully bound with tape. Then he was transfered to a trolley bed and into the ambulance with a police escort. He will spend the rest of the day...or his life, in a padded room wearing a restraining jacket I should think.

Be safe.

Tuesday, 26 February 2008


Thirteen emergency calls; one false alarm, one treated on scene, one gone before arrival, one running call (assisted-only); two further assisted-only and the others went by ambulance.

It’s not summer yet and the calls are increasing over the weekend already. Every year seems worse than the last. I have to assume we are (a) very popular, (b) overloaded or (c) there are more sick people in the world. A and C are both possible, although A seems unlikely and C would be worrying but I’m going with B.

I was very tired when I started tonight and my first call was for a 2 year-old girl with a head injury. The cause of her bleeding scalp was unknown because the two females caring for her couldn’t tell me. She had been left in the front room on her own and a bang was heard. This brought the women into the living room where they found the child face down, covered in blood. She was conscious but extremely distressed when I saw her.

I looked for a possible cause; no blood stains on the furniture, the corners of tables and chairs were innocent of the crime and there were no other heavy objects around – nothing. There was a cat in the flat, so the toddler may have tripped over the creature and fallen but her wound was at the very top of her skull, on the crown, so whatever she hit or whatever hit her made contact with that part. You have to have your head very low to sustain an injury like that from falling or something has to fall on you.

The injury had stopped bleeding, thanks to a towel which had been plonked on to her wounded cranium. I took a close look at it and saw that it was long and depressed at a point – the sort of injury that a hard, narrow object might cause.

The little girl eventually calmed down but she wanted to sleep, which wouldn’t have been a good idea, so I asked her carers to keep her awake as I examined her and waited for the ambulance. I don’t like being left alone for too long with a potentially seriously injured child.

The crew arrived after ten minutes and I had the women bundle the child up and take her down to meet them. I explained what the injury was and left my colleagues to transport her to hospital, along with the two very worried in loco parentis adults.

A call to the West End for a collapsed 40 year-old male next and I’m driving around looking for a windmill. The ambulance arrived soon after me and the crew looked too but nobody claimed us. Then an agitated woman brought the ‘patient’ to us – it was one of our regular callers – a dangerous timewaster and my would-be attacker from last year. He is notorious for lying on the ground pretending to be dying in the hope that a member of the public will call us out. Invariably they do and we wage a battle against the falsely raised concerns of a normal human being in order to convince them that we will not be taking this man to hospital because he will abuse the staff and then walk out, only to call again…and again.

Luckily, as soon as I got out of the car and he recognised me the story changed. The crew also knew him and were busily exchanging information about his notoriety with this very upset woman who had obviously taken to him. I don’t know why because he has the charm of a snake.

Coincidentally, 30 minutes before this call, another hoax call had been made in which the caller asked for all three emergency services and sent his regards to the fire service. I don’t believe in such coincidences where this guy is concerned but I just can’t prove it.

He shook his head and denied asking his new found friend to call us. He gave me a ‘she’s mad’ look and the woman remonstrated with the crew, who remained professionally patient with her as she practically insulted their lack of care for someone so ‘ill’.

Then, as the dust settled, she walked off with him, one loving arm around his dishevelled, unwashed and, at times, aggressive shoulder. True love.

I wasn’t required for the next job. The crew was already on scene and treating an 18 year-old female with Crohns disease who was complaining of DIB. All I did was pop my head around the door and smile. Inside the ambulance I could hear the girl screaming and wailing as if in enormous pain. I learned later that she was exaggerating somewhat.

Sitting on a platform bench at a railway station I found my next patient. He was a 61 year-old man with a history of MI. He had chest pain after travelling to see his daughter. He had forgotten to take his GTN with him and now his angina had kicked in. I gave him a spray and an aspirin and the pain got better. The crew took him to hospital, even though his ECG was unremarkable – better safe than sorry.

A 28 year-old female, with rolling eyes and flailing limbs slipped in and out of consciousness after taking a cocktail of alcohol, cocaine and MDMA. She was in trouble and needed to get to hospital quickly. If this was her idea of a good night out, we were about to spoil it. She got a needle in her vein and some fluids for her trouble.

A call to Tower Bridge, which is more than slightly out of my area, gave me two patients; an eighteen year-old guy with a head injury after having a bottle smashed over it and the world’s smallest 17 year-old, who was just plain drunk. The former had a laceration across his forehead and seemed to bask in the glow of his new found status with the girls around him (teenage girls just love a man with a battle scar). The police were on scene but that didn’t stop the audacious assailant from returning and looking over the bridge at his victim (and me) below. I hoped I wouldn’t see a bottle flying over towards us.

‘There he is, that f**king slag’, shouted my patient, with a few more insults emanating from the girls around me.

The police were very quick off the mark and they chased the violent teenager down, cuffed him and dragged him back to their van, much to the delight of the small gang of ‘innocents’ around me. The language used against the arrested man was pretty foul...and all within a few yards of a posh hotel.

The latter (and I know I got to him in a very long-winded way but thanks for waiting) was a small, bespecled youth who looked like the most likely geek you’ll ever meet. He had been encouraged to drink a LOT by his friends and now they were worried about him because he kept being sick and passing out. There was nothing medically wrong with him but he was a minor and there was no responsible adult to take him home. The one and only ambulance around at the time was busy with my head injury patient, so they couldn’t help.

In the end, I persuaded the mother of one of the other kids to take him off my hands. She knew him from nursery (obviously as a parent, not as a child) and would be able to take him home on the way to her own house. He had one of those first-time-drunk stupid smiles on his face as he left.

Another teenager with too much alcohol in her blood went to hospital after being awoken from her slumber on the floor of a club by the crew, who arrived with me. ‘Don’t hurt me!’ she yelped as the pinch to her shoulder muscle increased and she opened her drunken eyes.

As I crossed Trafalgar Square I noticed a street artist lying on the pedestrian area, wrapped in a cocoon of quilts and blankets. His artwork was still displayed on the pavement and his hat was still out. People had been dropping coins into it, regardless of the fact that it was late at night and he was obviously asleep. While I contemplated this, a man approached me and asked if I could help him. He was asthmatic and had forgotten to bring his inhaler – now he was in trouble and could barely breathe.

‘I thought I wasn’t going to make it home. Then I saw your car’, he wheezed.

I called it in and nebulised him there and then. It took ten minutes to recover him and he felt much better. He refused to go to hospital and he didn’t really need to now, so I left him to continue his journey home.

Just before I moved on a smartly dressed joker approached the car and said:

‘Excuse me, do you do stitches?’

Then he turned around, bent over and exposed a long rip down the seat of his trousers.

‘Can you stitch that?’

Ha ha.

My next call was to an invisible patient. The 24 year-old drunken girl's friends had taken her home before I arrived. Nice of them to let us know.

I drove up a narrow alleyway in Covent Garden to get to that last call and two men were walking along the pavement in the opposite direction. One of them deliberately prepared to flick his lit cigarette in through my open window. He changed his mind at the last minute but I was fully prepared to be burned. Some people have no excuse for their behaviour.

It had been too busy a night for everyone to go to hospital, so my next patient, a 21 year-old female, whose friends had called because they were concerned that she would dehydrate after vomiting a few times, was left at home in their care. I completed my obs but, apart from wasting everyone’s time at hospital, there was nothing that could be done for her...she needed to sleep off the alcohol that was making her sick.

I met Jim, the ‘No,no,no’ character from The Vicar of Dibley near the end of my shift. Well, it wasn’t him exactly but he sounded just like him. He was my ‘drunk on a bus’ call of the night. The 47 year-old man was asleep on the back seat and the crew and I woke him up and moved him on. He was a perfect gentleman and gave us no trouble. The police were on scene too (we get police back up with most of these calls now because of the threat of violence) and they asked him where he lived. He pointed to the bus.

‘I live on buses and trains’, he said.

Another MDMA nutter; a 21 year-old man who looked respectable and intelligent enough to know better was standing at a bus stop with his worried friend. He had taken two E’s and now he felt unwell. His heart was racing and he was dehydrated. Surprise, suprise!

He got a lecture from me and the crew and was duly taken off to hospital. It was going to be a long weekend of drug abuse. There must be a glut of smiley tablets on the street at the moment. Or there’s a sale on.

When I returned to Traffy Square in the late early hours, the street artist hadn’t moved – he was still asleep. His hat, however, was missing, as was the money it had contained. Someone had relieved him of it.
Be safe.

Monday, 25 February 2008

Advertising space

Seven emergencies – one running call, one conveyed by me, one time waster and four by ambulance.

There’s something distinctly cheeky about standing in front of a busy McDonald’s restaurant (forgive the gross misuse of that term) with an advertising board that declares ‘Burger King – 200 seats’ and a big arrow pointing away from the competition. Cheeky and amusing. Still, I’m sure those 200 hundred seats would have been filled as a result. We need a similar competitive edge in the NHS, I think. A big sign saying ‘REAL emergencies, this way’.

A 30 year-old carpenter from Iraq cut through his finger with a power saw on a building site and when I got there, he was being jostled out to me before I had a chance to properly assess him. His finger will survive but the cut was reasonably deep, although I doubt the toilet tissue sticking to it would benefit the laceration much. Its one thing to stop bleeding and quite another to introduce infection.

The site had no first aider and the first aid kit (which nobody would have been qualified to use anyway) was hidden away somewhere…or so the boss man told me. I smelled a rat and the whole thing smacked of a lack of care for the mainly foreign workers the company were employing. The patient had been wearing gloves, although they were flimsy and offered no real protection, and there were hard hats in use but the basic principles of first aid at work were obviously of no real concern to the firm.

As I packed him into the car for the trip to hospital, dressing and elevation sling in place, I warned the site foreman that he had a duty of care and that he needed to get it sorted before a more serious incident took place. I hope I embarrassed him into some kind of action but I doubt it.

Then a 48 year-old man with pancreatic cancer and diabetic problems became my next patient. He was at a work conference and had suddenly felt ill. I found him sitting on a settee, shaking like a leaf. His BM was high, as was his temperature and I discovered that, because his cancer had been quite widespread, his spleen had been removed. People without spleens can catch infections easily and are usually on antibiotics for life.

I spent five minutes with him before a crew took him to hospital, still shaking.

A call for a 58 year-old male ‘feeling dizzy’ had me searching for a patient. The call had come from a public phone box but there was nobody around – well, nobody who admitted calling us. The crew duly arrived and together we scoured the local area, only to find our man sitting on a bench at a bus shelter 100 metres from the given location. As soon as I approached I recognised him. He is a very regular timewaster. He has no genuine illness but he calls us a LOT. He recognised me too and his face dropped.

A concerned woman told me that he was unwell and he plonked himself down beside her, giving her full details of his need for an ambulance. She believed his story, so I went over to him for a chat. There was a very brief exchange and he walked off because he knew he wasn’t going to get anywhere this time. He was offered the chance to be checked out in the ambulance but he sensed the game was up.

I don’t mean to sound harsh or cruel and I’m sure a few of you will be thinking ‘but what if he really was ill this time?’ Trust me, he wasn’t and I can assure you that he had every intention of wasting time in hospital; he knew how to get the best attention – call an ambulance. I know this because he was sitting at a bus stop directly across from the hospital A&E department. He could have walked there as easily as he had walked to where he now sat. Ka-ching.

Another dizzy person, this time a 77 year-old woman, wasn’t wasting our time, however. She had been discovered on the floor by the meals-on-wheels people. She was wedged in between her bed and a chair. She had been incontinent and the smell of urine was quite overpowering. She was also very confused and seemed to think everything was fine. I learned from a carer (her neighbour) that she suffered from Alzheimer’s, so her state of mind was always questionable. Even though she refused help, she was gently lifted onto her old sofa (with the help of the crew who had just arrived) and checked out thoroughly. She would need to go to hospital, for her own safety if nothing else.

Not many 80 year-olds are out riding bikes these days but my next call was to an active Octogenarian who had allegedly been knocked off her wheels by a taxi in a narrow one way street. I found her lying on the ground with a head injury and a possible broken wrist. There were no eye witnesses and the taxi driver adamantly refused to believe he had made contact with her. ‘She just fell off in front of me’, he said

The woman was just as adamant that he had hit her, describing her fall as ‘flying off suddenly’. She seemed mentally able to make that judgment and didn’t appear to be confused at all, so the police had to reconstruct the incident and as I like a bit of detective work, I helped them look at the scuff marks on the taxi and compared them to the damage on the bike. The rear wheel was completely bent and I couldn’t see how a frail five footer could have caused such damage, even if she landed on it from a height, so I had to assume (and the cops agreed) that she was probably knocked off her bike and that the taxi’s front wheel had gone over her rear wheel…and her wrist, since her head injury had been caused by the landing and was on the opposite side to her wrist injury.

I left them on scene to work it out and the crew took the old lady to hospital. She had been lucky not to be crushed to death under that cab.

I went over to Traffy Square and sat on stand-by watching a group of young homeless alcoholics kick a ball into a makeshift goal (the wall of the National Gallery), which sounds like fun but I don’t think they were too concerned about the people walking around or the fact that this is also where toddlers toddle and a ball in the face is no fun for a two year-old. They were stopped by the Gallery security people who thought it was bad publicity.

On my way back to the station I waited at a red traffic light and when it turned green I cautiously moved forward. I have no idea why I felt the need to keep it slow for a moment but as I crossed the busy junction a cyclist sped straight through the opposing red light. If I had been travelling at a normal speed I would definitely have had him for company through the window of my car. How then would I have explained the rest of my day? Thanks, you selfish misery-bringer.

A 17 year-old pregnant girl with a polycystic ovary and no boyfriend (since he left her alone when he found out about the baby) was sitting crying at a tube station because she had abdominal pain. She hadn’t been told about her ovary but it was in her notes…I’m not sure if that meant she couldn’t read but I read what the doctors had written so that she was at least aware of why she might feel pain. The medics weren’t negligent; the fact is she is too lonely and despondent about her situation to bother with details. She was a frightened child carrying another child and she just needed help, so she got it – from the tube staff, me and the sympathetic crew.

As soon as I finished with that call and just as I packed up to leave the scene, I was asked to help out with a diabetic who had become ill on a train. He was being brought up for me, so he couldn’t have been that sick, I thought.

When he arrived at the station office, he was drinking coke, courtesy of the Transport Police (a nicer bunch of people I’ve yet to meet). He was already recovering well and his blood glucose level was improving, although I hadn’t tested it originally, it was climbing above 4.0 when I did, so that was encouraging.

He didn’t want to go to hospital but I had to wait with him to ensure that he fully recovered.

‘You don’t drink alcohol, do you?’ I asked.

Of course he didn’t; he was a good Muslim man and he insisted on walking over to the station shop and buying everyone a bottle of coke. The police followed to steady him and I watched as he piled bottles into a plastic bag before returning, with a much steadier gait and placing them on the floor.

‘These are for you all. Thank you all very much’.

‘Thank you’, I said.

‘No’, he replied, ‘thank you for being you’.

I don’t know why I bitch about getting no thanks when one like that is worth ten days of being invisible.

Be safe.

Friday, 22 February 2008

Actor's union

Now there's something you don't see every day!

Five emergency calls – one assisted-only and four required an ambulance.

A cold, crisp morning but the sky promised me a pleasant, sunny afternoon ahead. Nothing lifts my spirits more than working in Central London when the sun is shining and the air is warm. Its half term for some schools, so there are tourists and families mixed together and they are all going to cross Trafalgar Square at some point…they all do eventually. That means a buzzing atmosphere and free entertainment from the local dancers and musicians and that’s good when I’m on stand-by.

Until then, I find myself on the top floor of a house, in the small and untidy bedroom of a 41 year-old man who lives with his mother. He has been short of breath since getting up this morning. I look at him and I see that he’s not kidding. He’s not hyperventilating out of panic and he’s not suffering from asthma, even though he is an asthmatic. Something else is going on.

His breathing rate is in the high 30’s per minute and his pulse is continually fast and weak. In fact, I can’t find a radial pulse at all at first. I can’t get a blood pressure reading either, so I put him on oxygen and wait for the crew to show up. The O2 helps him and his breathing slows down but he remains tachycardic and scared.

He tells me he’s been to his GP for tests but nothing has been diagnosed. His asthma is well controlled and he took his inhaler when this started, just in case. But I detect no wheeze and there is no tightness in his chest. He’s breathing like a man with heart failure. It’s clear he isn’t carrying enough oxygen in his blood and the reason for this hasn’t been discovered yet.

The crew arrive and we take him to the ambulance for further checks. On the way, he needs to pee, so he goes to the loo without oxygen. A few minutes later he comes back and he’s completely out of breath. He’s behaving like an unfit 80 year-old. He’s not overweight and he doesn’t have a cardiac history. He’s younger than me but he can’t put one foot in front of the other without feeling weak and dizzy.

In the ambulance his blood pressure is taken and it’s low. His heart rate is still fast and remains that way all the way to hospital. He has a history of PE; he had one a few years ago but he is feeling no pain. To me, that makes little difference as pain is not necessarily a definitive signature for PE. I think he’s having another one to be honest.

I left him in the Resus department with a doctor and nurse trying to figure out what his problem might be. Somebody needs to test him for lung and cardiac function. His ECG wasn’t normal. He is deteriorating.

Trafalgar Square next and an hour of stand-by in the warming sunshine. It’s like spring and I want to wander around but I’m called to a job well out of my area for an unconscious ‘? Cardiac arrest’ which has been relayed by the police.

I raced to the scene but was intercepted before I got there by a police vehicle. The patient I was heading towards was just drunk and they had managed to move him on but they had another call, this time to a drunken female who had fallen and they asked if I would attend with them. Being the happy to oblige soul that I am, I drove round to the address with them and let my Control know what I was doing. This confuses the paperwork, you know.

On the street, below a set of steps leading to an estate block, lay a middle-aged lady. She was in the throes of insulting the police officers around her and they invited me to calm her down. Yeah, right.

‘Hello, what’s your name?’ I asked with my professional LAS voice.

I got one of those long hard but ever-so-slightly out of focus looks that drunk people, especially women, give. Sometimes it’s accompanied by ‘who the hell are you?’ or ‘F**k off’, or some other excuse for an answer. This time I got a long, silent and almost psychiatric gaze. Every second or so, her eyes would lose track of me and her head would nod forward involuntarily, only to be snapped back to regain the territory she had fought so hard for (my attention).

‘Why are you lying on the ground?’ I enquired.

Staring silence. Then a quick reference to the police officers. It took twenty minutes to convince her to talk to me and when she did, she wouldn’t stop. I got her life story (recent history) and a request to let her go away with the handsome police officer that she had taken a shine to.

‘I fancy him’, she said, pointing a gnarled finger in his general direction. The officer was probably 24 years-old. She was at least 50.

She was a long way from home and was trying to visit her dying father, or so she told us. Her emotional state would best be described as unstable and her physical condition (drunk) merited a trip to hospital for her own safety. She had already tumbled down the steps and she could barely get up herself, never mind walk anywhere. So, even if it came to citing the Mental Health Act, she was going. She overheard this discussion and let us know how she felt, in a very loud voice.

‘Okay, I’m going to hospital because I’m mental now!’

Nobody disagreed.

The crew arrived after my second request via the police (they had forgotten he first one) and she was duly packed off to a better place. I then made my way back to familiar territory.

A 35 year-old faker had us looking like fools when he collapsed inside a Home Office building where permits for entry to the UK are scrutinised. Two security men were pinning him to the floor because he had been thrashing around so violently and they were reluctant to let him loose. I arrived with the ambulance crew and a cycle responder joined us (I had passed him on the road as he pedalled to the scene at full throttle). We all looked at him lying there and we all knew he wasn’t having a fit, epileptic or otherwise.

He also pretended to speak no English and everything was translated for us by a member of staff in the building. As soon as we got him into the ambulance, he settled down but still insisted on trembling and shaking, making life difficult for the crew.

‘You can stop now because nobody is here except us’, I said. I was gambling on being right with this patient.

He nodded and stopped.

‘So, you can understand and speak English, can’t you?’ I said.

‘Yes’, he answered.

Shameful. The whole act was a distraction designed to get him out of there and into hospital where no awkward questions would be asked. I could feel another few pence of my hard-earned tax money being ripped from my pocket by him.

On my way back I drove up Whitehall and glanced over at the mounted guards as they suffered the tourist crowds and happy snappers all around them. A taxi stopped directly in front of the gate of Horseguards to let a passenger out but one of the guards moved his horse forward and out of his sentry box to tell the driver to move along. It was the first time I had seen one of these soldiers do something that was distinctly non-touristy. No offence to them, of course. I mean it reminded me that they had a function and that they did more important things. They obviously guard those gates but I think the tourists should be kept further away from them...people get far too close to those soldiers and their mounts.

I got back onto Traffy Square and was approached by a homeless man. He shoved a photograph through the open car window. I took it from him.

‘Have you seen this dog, mate?’ he asked.

I looked at the picture. A small, mongrel dog (Alsation cross) stared back at me.

‘Sorry, no I haven’t seen him. Why?’

‘I’ve lost him. He’s been gone since Valentine ’s Day’. He’s called Shiney.

He was almost tearful and I felt genuinely sorry for him, especially knowing how much these people value their dogs. They offer companionship and protection, two things you really need when you are homeless and living on the bottom rung.

I promised I would look for Shiney wherever possible and that I would tell my colleagues to keep an eye out but I couldn’t imagine what I was going to do when I found him. I couldn’t take him into the car and the police wouldn’t be interested, so I took a contact number from him.

He shuffled off and I realised that even with the best intentions and a telephone number, I wouldn’t be much good to him because I couldn’t hold on to the animal if I spotted it and I wasn’t able to hang around with it if I did. I think he’s lost his dog for good. Someone probably stole it.

Please don’t walk up to me with a stupid smile and ask me for a hug because you ‘feel sad and unwell’. I’ll say no. Especially if you are a tall, skinny student who is creating attention for himself so his friends can have a laugh. Go away, I’m working.

Drops in blood pressure in the elderly can be sinister or completely innocent, depending on predisposing histories and the rate of recovery of the affected person. An 80 year-old who collapsed at a posh restaurant during a meal with her friends rapidly recovered and was doing well when I arrived. She didn’t seem worried and her blood pressure was rising again after the rest. She had no significant medical history or current problems to speak of and she adamantly refused to go to hospital.

The crew took her to the ambulance and she was given a quick check-up. I finished my paperwork in the car and gave refuge to one of the lady’s friends as she waited for the results of the ECG. It took fifteen minutes to declare her well (in terms of the tests we can carry out) and she decided that she still wasn’t going to hospital. Instead, her friend (the one in my car), would take her home, so she was given advice and off she went.

It’s been one of those days. The last call, for a 47 year-old man with chest pain, took me to an underground station, where a crew had arrived just ahead of me. This job was going to make me late getting home and it wasn’t helpful to see how the man mimed his pain and referred to it only when asked. He was homeless and play-acting. All the way to street level, up two escalators and two flights of stairs, any of which could have caused my colleagues injury had they misjudged them, he didn’t complain at all – he sat and allowed himself to be carried by men who were in the same condition as he was – fit and well.

Be safe.

A couple of things

I was sent the following by Jeanie:

London Times Obituary of the late Mr. Common Sense

'Today we mourn the passing of a beloved old friend, Common Sense, who has been with us for many years. No one knows for sure how old he was, since his birth records were long ago lost in bureaucratic red tape. He will be remembered as having cultivated such valuable lessons as: Knowing when to come in out of the rain; why the early bird gets the worm; Life isn't always fair; and maybe it was my fault.

Common Sense lived by simple, sound financial policies (don't spend more than you can earn) and reliable strategies (adults, not children, are in charge). His health began to deteriorate rapidly when well-intentioned but overbearing regulations were set in place. Reports of a 6-year-old boy charged with sexual harassment for kissing a classmate; teens suspended from school for using mouthwash after lunch; and a teacher fired for reprimanding an unruly student, only worsened his condition. Common Sense lost ground when parents attacked teachers for doing the job that they themselves had failed to do in disciplining their unruly children.

It declined even further when schools were required to get parental consent to administer sun lotion or an Elastoplast to a student; but could not inform parents when a student became pregnant and wanted to have an abortion.

Common Sense lost the will to live as the Ten Commandments became contraband; churches became businesses; and criminals received better treatment than their victims. Common Sense took a beating when you couldn't defend yourself from a burglar in your own home and the burglar could sue you for assault. Common Sense finally gave up the will to live, after a woman failed to realize that a steaming cup of coffee was hot. She spilled a little in her lap, and was promptly awarded a huge settlement.

Common Sense was preceded in death by his parents, Truth and Trust; his wife, Discretion; his daughter, Responsibility; and his son, Reason. He is survived by his 4 stepbrothers; I Know My Rights, I Want It Now, Someone Else Is To Blame, and I'm A Victim.Not many attended his funeral because so few realized he was gone. If you still remember him, pass this on. If not, join the majority and do nothing.'

And this link to a new site called, giving an example of the type of videos that are uploaded with EMS relevance. There's some funny stuff here.


Wednesday, 20 February 2008

Radio update

Sorry! I've been asked by a few of you to provide links to the stations so that you can listen in later on. So, I have provided an updated list of shows, live and pre-recorded, with (hopefully) working links either directly to the station home page or to the 'play again' screen. You may need to download a player to hear the shows though!

It's all going well so far but I'm a bit nervous about the speed of it all. Won't stop me doing my night shifts at the weekend though, will it?


Tuesday, 19 February 2008

Unhappy Valentine

This is Jack. He is a police sniffer dog and works for the British Transport Police. I met him when I visited a police friend of mine for a coffee and a chat (obviously the coffee and chat weren't with Jack). He is looking away, despite being asked to smile because he is looking at his master. These dogs only have eyes for one person - their handlers. Stroke him all you want but don't be carrying drugs when you do it!

Five emergency calls; one cancelled on scene, one treated on scene and three taken by ambulance.

An over the top response for a twisted ankle on Valentine’s Day and my shift was just kicking off. The call had come through as a RTC involving a vehicle and a pedestrian. The caller had obviously got excited about the injury and had created more scope for a 999 call. The lady could have hopped to hospital – she certainly didn’t need a FRU and an ambulance with bells and whistles. What is happening to society? Where is our sense of self-reliance and responsibility? What happened to common sense? It’s bad enough to hear that this man is suing a bookmaker for millions because they didn’t try to stop him gambling all his money away!

The 24 year-old who should have known better was taken to hospital and the ambulance was tied up for at least an hour because of a simple sprained ankle, if indeed it was even that bad.

Epileptics in trouble certainly need an ambulance and so my next call, to a 41 year-old who was fitting at work felt like a genuine mission. He was post ictal when I arrived; very confused, pale, sweaty and determined to get off the floor but his colleagues and a nurse (who just happened to work for a private clinic in the office on the next floor) were there to gently restrain him.

I knew he would be fully recovered in twenty minutes or so and all I had to do was carry out my obs a couple of times and monitor him until he improved enough to make a decision about going (or not) to hospital. Most don’t.

His wife had been contacted and I spoke to her on the ‘phone. She told me she would come and take him home, as she usually does when he has a fit. This was his first in six months and she knew exactly what to do, so I agreed with her plan. She warned me that he may fit again, so I kept a close eye on him while I waited but he just got better.

The crew arrived and waited with me until his wife got there and he was able to leave with her. He had fallen hard onto the floor and when he became more lucid, he started to complain of severe shoulder pain. He may have pulled a muscle or fractured a bone, so he was advised to go with the crew to hospital and get it checked.

You know I like to keep you apprised of my idlings when on stand by, so here’s what I got up to whilst sitting in the car waiting for my next call. For the first time in my life I bothered to notice that the flashing lights on those zebra crossing posts never seem to go out. I mean, I’ve never personally seen them NOT flashing. That means that there is someone, somewhere whose job it is to either cruise around monitoring them for function, or to replace the bulb when a fault is reported (by whom I don’t know – like I said, I’ve never seen one out of order but I’m not so sad as to call it in if I did).

I took the opportunity to calculate the number of times these bulbs flash (I had nothing better to do and I knew you’d be very interested…except for my foreign readers who may not even know what I’m talking about). I counted 48 flashes per minute – so they flash 2,880 times per hour, 69,120 times per day…a staggering 25, 228,000 times each year (25, 297,920 in a leap year if you’re interested). Pretty damned good bulbs. Probably Japanese.

My next call was cancelled when I arrived on scene. A 65 year-old with chest pain was being assisted by an ambulance crew and I wasn’t really required but I helped them with bits and pieces. I might as well be of some use on scene, I thought.

A stupid young man who thinks he’s got everyone’s illnesses brought me into a small flat on an estate in the north. His sister shook her head as he moaned about chest pain, then food poisoning, then allergic reactions he has to every food on earth.

‘He’s lying’, she said.

I considered the possibility that he was an attention seeker then I thought about mental illness, which can never be ruled out, even in a 21 year-old. His mother stood by but she said almost nothing. She looked fed up.

When the crew arrived, he told them a completely different story to the one he had reported to me. ‘I’m standing right here!’ I thought.

I heard his sister tutting every now and again and I felt her embarrassment.

The crew took him to hospital, despite finding absolutely nothing wrong with him (physically at least) and his suffering sister went with him. There was no hand-holding and no sympathy.

A local job next (well, local to my station). A 35 year-old female had been found unconscious in the ladies' toilets of a restaurant. Staff had found her and they reckoned she must have been there for about two hours, although that would mean nobody went to the loo in all that time or that they completely ignored the lifeless body in the cubicle.

When I arrived, I got cancelled for a nearer vehicle. The MRU was on scene but I knew that he would need help if this was what I thought it was. The call was given as a query overdose because there was a ‘needle hanging out of the arm’. This sort of eye-witness fact lends credence to the nature of the call and, unless the needle was a piece of jewelry, this patient had more than likely taken heroin.

I let Control know that I was going to help and once inside I found my colleague struggling to manage the limp body of a young woman who was bent inside a cramped space. He asked me to get my BVM (bag-valve-mask) and I knew he had found her either not breathing or breathing so inefficiently that she couldn’t survive. Heroin does that – it depresses breathing and enough of it can kill very quickly. This addict had injected so much of the stuff into her vein that she didn’t even have time to remove the needle and syringe from her arm – she had just slumped into unconsciousness. It can’t be worth the money she paid for it.

When I returned with my BVM, the MRU medic had given narcan to reverse the effects of the drug. If it worked, she would start breathing normally and recover to consciousness. It’s a cheap way to save a life.

The ambulance crew arrived as I was preparing to help with the possible resuscitation of this woman but before we had to go that far, she began to show signs of life – her breathing improved. A few moments later she opened her eyes and looked around, bewildered. She had such a look of surprise that you would be forgiven for thinking she had just unwrapped a Christmas present and found an old pair of socks.

‘What happened?’ she croaked.

‘You overdosed and nearly died’, my colleague replied.


My colleague repeated what he said but she shouted back at him.


She couldn’t hear him. He raised his voice, as did we all but she plainly had great difficulty hearing. At first we thought she may have taken some bad drugs – we have been told of dodgy stuff going round and it causes problems like this, but she told me that she was a ‘little deaf’ anyway. A little deaf? She was very deaf. It crossed my mind that she might want to try swapping her heroin addiction for a hearing aid.

She was a petite woman, about five feet nothing and thin (they all are eventually) and she looked very vulnerable. She wasn’t the ‘usual’ kind of addict; she was less harsh than the others tend to be (I’m sure we’ll be banned from stereotyping druggies soon) and looked almost innocent in her predicament.

She told us she’d just been released from prison. This was the second time in a few months that I have dealt with a young female who had overdosed in a public place within a day of being released from Her Majesty’s B&B. I thought drugs were easy to come by inside but there is obviously a rush to get to them on the outside. Maybe women’s prisons are stricter.

She was gobsmacked that she had nearly topped herself, albeit by accident.

‘Oh God. I took too much, didn’t I?’ she said without a sob or an ounce of real feeling. She said it the way you would say ‘I overcooked the chicken, didn’t I?’

The staff member who had discovered her saved her life and we put in the hard work to ensure she could go out and get wrecked on drugs again sometime soon. I felt no satisfaction about that and my colleagues, some of whom have been doing this job a lot longer than me, looked resigned to this state of affairs. None of us will change the world but I would like to retire someday with a sense of having achieved something. I won’t be doing it as a frontline paramedic ‘narcing’ drug addicts, that’s for sure.

When she fully recovered we let her go. She wasn’t interested in going to hospital and she would have walked out on the medical staff anyway. She would have been a waste of good paper and ink. This is unfortunate because, without the drug habit, she would probably have been a useful member of society. She didn’t appear to be stupid and her deafness gave her a vulnerability that merited care and attention. Still, she was more interested in finding her boyfriend. It was the day for lovers after all. He was apparently waiting for her outside somewhere. He wouldn’t be pleased because she had just used up his share of the drugs too.

We watched her wander off, to and fro, trying to spot her mate. She walked past us.

‘I can’t find my boyfriend’, she lamented.

None of us were surprised. She’d been stitched up. He probably cared less for her than he did about his love affair with the brown stuff. Soon enough, she was gone and we were forgotten. I hope never to see her again but if I don’t it will only be because she has moved, gotten clean or died.

Be safe.

Saturday, 16 February 2008

Radio Ga Ga

If you are interested, I have a number of radio interviews lined up to promote the book. There hasn’t really been any serious effort to raise awareness of ‘Life & death on the streets’ because the Christmas period is a bad time to do it, so it’s all kicking off now and I’m going to be busy by all accounts.

Here is the list if you want to listen in, otherwise I will try to stick the podcasts onto the blog and you can download them any time you like. My first interview took place on Friday for BBC 3 Counties Radio – you can listen to that here for the next few days only. You need to click on the LORNA MILTON show and scroll forward in time until about 4.15pm to catch it.

The upcoming shows are as follows (Follow the link and click on 'listen again', scroll through to the correct time and hope it works!):

Wednesday 20th
Time Radio Station, presenter
9.00am BBC Radio Humberside - Morning Show

9.30am BBC Wiltshire/Swindon - Ollie Dearden

10am BBC Southern Counties - live with Neil Pringle

10.30am BBC Newcastle (pre-recorded for 2.30pm) - Alfie Joey

11.00am BBC Bristol - live with Dave Barrett

11.30am BBC Manchester - live with Heather Stott

12.00pm BBC Merseyside (pre-recorded for Thu 10am) - Shaun stiles

12.30pm BBC Coventry & Warwickshire - live Annie Othen

1.00pm BBC Solent - live Charlie Crocker

1.30pm BBC Stoke (pre-recorded for 4pm drivetime) - Paula White

2.00pm BBC Hereford & Worcester

Thursday 21st
9.00am BBC Sheffield (pre-recorded for ??)

9.30am BBC Lancashire - live with Steve Royle

10.00am BBC Shropshire (pre-recorded for ??) - Brett Davison

10.30am BBC Cumbria - live with Ian Timms

11.30am BBC Cambridge (pre-recorded for ??) - Claire Ashford

12.00pm BBC Berkshire - live with Henry Kelly

1.00pm BBC Gloucester (pre-recorded for ??)

Wednesday 27th
11.00am BBC Asian Network Radio

2.30pm BBC Radio Five Live - Simon Mayo


Dee and Vee

Six emergencies. All of them went to hospital by ambulance.

A shift clear of timewasters. How unusual.

It all started with a 35 year-old female who had been hit by a motorbike as she crossed the road. An ambulance was ahead of me because my navigation system decided to send me down the wrong road and I spent a minute or so correcting the mistake. By the time I arrived there was a police presence and the crew had organised themselves on scene.

At first I couldn’t see anyone hurt. All I saw was the back of an ambulance and one of my colleagues chatting to a leather-clad motorcyclist on the pavement as the police looked on. His crew mate was walking back to the ambulance but there was no hurry in his stride. I took this to mean that the call wasn’t as given and that nobody had been injured, so I called my Control and told them I wasn’t required but it was a hasty move. I got out of the car on instinct and looked around. In front of the ambulance, out of sight, was another vehicle – this ambulance was protecting a woman on the ground and the crew were attending to her. I walked over to see if I could help and I was asked to put the collar on. She wasn’t badly hurt and all of this was precautionary but I should have taken a little more time about surveying the scene before assuming it was clear for me to leave. Too early in the morning for me I think.

It wasn’t essential for me to be there. The other crew were around and I was just an extra pair of hands but I mucked in because that’s what we do if we can. The woman was crying and clearly upset about her current situation but physically she seemed fine.

‘What day is it today?’ one of my colleagues asked. He was trying to assess her for possible mental impairment (we do that for head injuries as a matter of routine).

‘Oh, isn’t it nearly valentine’s day?’ she replied, sobbing and trying to laugh at the same time.

‘Do you have a valentine?’ I asked her. She was a pretty woman so I was expecting a positive reply, thus cheering her up with the thought of an impending celebration (you know, cards, flowers, chocolates).

‘No’, she said. It wasn’t the reply I had been expecting. It surprised all of us and it left me with nothing positive to say because the follow up to that eluded me at first. So I just said something lame and useless like ‘I can’t believe that.’

As they packed her into the ambulance and calmed her down (I don’t know if I set her off again or she was going to start up again anyway) I asked my MRU friend to let me have a piece of paper. I scribbled out a make-shift valentine’s ‘card’ from all of us in the LAS and handed it to her. She beamed and so I think I was forgiven. I had written ‘Happy valentine’s day from the LAS’. I think I drew a flower on it for her. I can’t remember but it would have been badly drawn if I did.

A 15 year-old school girl with severe D&V next. She had suddenly started throwing up in class and was now sitting on the loo with unstoppable diarrhoea. I had to assess her while she sat there. The poor girl was a mess – pale, sweaty and miserable looking. The way you tend to look when your body is trying to dry you up completely. She obviously had an infection, probably a bacterial one.

The crew took her to the ambulance as soon as she felt safe to come off the loo. At least throughout the drama she was well covered by her school uniform, so there was never an inappropriate moment for us to deal with. Two members of school staff were there also and one of them accompanied her to hospital. We prefer not take to take minors without a chaperone.

During the 20 minute wait as she purged herself, children queued up to get in. The teachers shooed them away but they just kept coming. Not surprisingly, as soon as it had gone round the school that there was a paramedic treating someone in the girl's toilets, every teenage female in the building suddenly needed to go. I'd like to support my ego by believeing that it was me they were coming to look at but they were just being nosey and, typically, enjoying the sight of one of their own in some distress. Compared to that, an ambulance crew really isn't that big a deal.

As I returned to my station, I was approached by a man who said someone was having a heart attack down the road in a nearby estate. I called it in as a running call and asked if the MRU paramedic, who I knew was in the station, could join me in case I needed an extra pair of hands.

The 80 year-old man was lying in the car park of the estate, groaning in pain. There were several people with him, including his neighbour.

‘What happened?’ I asked.

‘He was shouting at the workmen in one of the flats because he’s had enough of the noise. He got really wound up then clutched at his chest and said he was having a heart attack’, the neighbour replied.

Apparently, the workmen were renovating a flat which had recently been bought and they had been knocking, banging, crashing and drilling for weeks, every day, ten hours a day. The old man hadn’t slept properly for most of that time and he had snapped when he went out to remonstrate with them. As he stood below the window of the flat, shaking his fists and screaming abuse at the builders, his angina had kicked in.

I gave him GTN and an aspirin and within a few minutes the pain had eased. His wife joined us with a concerned look but she was more interested in telling him off for not having his spray with him. He was taken to hospital but he will probably have been discharged a few hours later. He’ll be fit to fight again soon.

A long run up into the north for a 50 year-old man who had been hit by a bus. It took me ten minutes to get there but there was nobody closer. When I got on scene, the police were chatting to a man with a cut head. He had been struck across the forehead by the bus as it pulled in – he had been too close to the edge of the kerb and had paid the price. Luckily for him, he was only slightly damaged. The crew were on scene soon after I started getting the handover from the police and I passed him on to them immediately. He was a walking, talking minor injury.

Another D&V. This time a 26 year-old male but this call was given as ‘chest pain’ for some reason. He had all the same problems as the schoolgirl earlier and was taken to hospital accordingly. There’s not much I can do for a patient like that unless he is so severely dehydrated that fluids are required but he’d have to be in a state of near hypovolaemia (fluid loss shock) for me to consider such an intervention when a short trip to hospital would speed up the management of his condition.

My final call took me to a tube station where a 60 year-old lady had fallen down the steps and hurt her hip. To me it looked like it could be fractured. She couldn’t put weight on the leg on the injured side without crying out in pain and she was one of those stoical types, so I had to assume she was feeling a lot more pain than she was demonstrating emotionally. She refused the offer of pain relief and was even refusing to go to hospital, so the crew were left to persuade her without bullying her too much. It was important that she went and got that hip checked out because, as she had told me earlier, there was a familial history of osteoporosis and she was currently taking calcium supplements.

One of the crew looked to be in some discomfort herself and when I asked her if she was okay she told me that when she arrived and got out of the ambulance, a taxi clipped her shoulder blade with its wing mirror as it pulled away. She ran after it and shouted through his window at the driver.

‘You just hit me, do you know that?’

‘Yeah, I know’, he allegedly replied. The he promptly drove away without another word, least of all an apology. Technically, this is still a hit and run and I was disgusted by what she told me. Now she was unfit to carry the patient up the stairs to the ambulance and would probably have great difficulty finishing her shift without endangering herself.

I offered to help with the lift when the patient finally agreed to go to hospital and we got her upstairs without a problem. My injured colleague had taken the cab’s registration number, so hopefully she has now reported the incident.

As I prepared to leave the scene a middle-aged lady asked me to check her blood pressure because she had just been insulted by a ‘foreign person’ and was worried about her health. She was clearly well-to-do and carried an air of authority. She spoke with a posh accent but that didn’t mean she was completely well and her behaviour suggested emotional problems. She was on the verge of tears with every word she spoke.

I checked her blood pressure at the roadside and it was a little high.

‘Its fine but you should go and see your G.P. tomorrow and get a second opinion just to make sure’, I suggested. I figured the slight elevation in pressure was down to her current emotional state but I wasn’t going to stand in the street and tell her something that would most likely send her over the edge of whatever imaginary tall building she was on top of.

I managed to get her to smile and calm down. I told her I had to go, which was true and she relented after a few more minutes. She melted into the crowds and the static she had drawn on ebbed away. Thus, the shift ended and I returned to my own world of relative normality.

Be safe.

Saturday, 9 February 2008

Under the radar

Eight calls (but it felt like a lot more): two refused, one false alarm, one possible hoax and four by ambulance.

Thursday nights are usually busy. This is the first night of the unofficial weekend when students with nothing to learn on Friday, the unemployed benefit-wealthy and seasoned clubbers get together to make the West End a noisy place. Strangely, I prefer it that way, even though there will be virtual no-go areas for young people by about 3am (when the nasty elements prey on the drunken innocents).

It was also a clear and quiet night weather-wise; stars in the sky and no wind at all. The winter chill was barely perceptible, which explains why a lot of the fun-lovers out and about chose to wear their summer clothing.

Of course, there was no chance of completing my vehicle and equipment checks before the first call came through. I was off to see a 25 year-old man about his epileptic fit. He was at work in his City office and his anxious colleagues were buzzing around him as I attempted to get some answers about his condition from him. He had fitted for 2 or 3 minutes, according to his friend but now he was recovering – he was still a bit confused but he could talk to me.

‘I take epilim’, he told me. This is the medicine he needs to take regularly to prevent a fit from occurring.

‘And have you taken it today?’, I asked.

‘No, I’ve missed it for the past couple of days’.

That’ll be the reason he’s had a fit then, I thought. I still don’t understand why people skip vital prophylactic drugs when they know what will happen when they do. I can’t believe its simple forgetfulness because taking the stuff would surely become second nature after a few years. Still, I guess until I am bound to take pills every day I will never know the reason.

The man’s boss was a bit nervy about the whole thing and when I told him that he had refused to go to hospital, he insisted on trying to persuade him to do so, even though I had just spent twenty minutes doing just that. It irritated me a bit to be honest. I suggested that further discussion could be seen as coercion and that the patient had made his mind up now, so it was up to him. I also said that I was waiting for the crew to turn up and maybe they could get him as far as the ambulance for further checks if need be.

This provoked a prickly response from the boss and he decided his duty of care outweighed mine. He even got on the phone to get ‘legal advice’ about where he stood. It was getting ridiculous.

‘Why don’t you just let me do my job?’ I asked as he dialled the number.

‘And I’ll do mine’, he said haughtily as he walked off.

Now, I admit, I may have rubbed him up the wrong way by being insistent about leaving the patient alone once his mind had been made up but I had my own plans for his care. There was a risk that he would fit again tonight but this had happened to him before and he had dealt with it himself, so there was no reason to badger him further. His boss had no authority to demand he went to hospital – it was best to leave it to plan B; the one where the crew get to chat to him before we all left him in peace. Nothing bugs me more than people who call ambulances and then believe they can do a better job than the people who turn up in uniform.

In the end, the crew couldn’t talk the patient out of his decision either. He agreed to go home with his friend and call an ambulance if he felt unwell at all later. The boss man was silent now.

A run across the length of Euston Road for a 60 year-old man who had collapsed next. He was drunk and a group of Polish men had gathered around him to standing around him. I got the man to sit up and asked him my usual questions about his drinking habits and how much he had consumed tonight, etc. Then the crew arrived and plucked him from the road. Now he will get a free ride to hospital, a free bed and a free doctor to make sure he is free of disease.

As soon as I ‘greened’ up I got a call which took me all the way back across the Euston Road to Mayfair, where a 35 year-old with a nut allergy was having a reaction to...nuts. Incredible.

When I arrived he was walking out of the restaurant to meet me. He was rubbing his throat but didn’t look distressed at all. I got out of the car and confirmed that he was my patient.

‘Do you have an Epipen?’ I asked.

‘No’, he replied.

Usually (but not always), people with life-threatening anaphylaxis will carry a prescription Epipen or Anapen, containing Epinephrine, which they can self-inject to slow the reaction down and buy time before the ambulance arrives. So, those without it are generally (but not always) safe and will usually be having a mild reaction which can be reversed using an antihistamine.

His neck was red and he said that it felt a little swollen inside his throat. Apart from that, he was stable and not in any clear danger. However, anaphylaxis is not to be underestimated and the very fact that his throat was swelling meant he could become acute within seconds.

The ambulance crew took him to hospital where he will probably be put on an antihistamine drip or given a couple of tablets to swallow, if his throat isn’t too bad.

A drunken tumble down a couple of concrete steps at an underground station next and I found myself looking at a pair of dry-skinned, flaky feet for evidence of injury. The 65 year-old had missed a step as he walked down towards the entrance. He had fallen clumsily and twisted his ankle. His right foot was painful, so I looked at that first – he had a slightly swollen ankle. Now I had to look at the other foot and compare them. I don’t mind this procedure at all but it is most unpleasant when the patient’s feet are unfit. I have colleagues whose worst nightmare is other people’s feet - they'd rather scrape a body off the ground than deal with smelly, yellow feet.

The man had a grade I sprain, so nothing to worry about but he would have to go to hospital to get it examined properly. Although he had been drinking, he wasn’t too worse for wear. He could weight-bear on his injured foot, so he was limped out to the ambulance.

My next call was for a 2 month-old boy who had stopped breathing and become floppy for a short period. I arrived to find his mother holding him and his worried family gathered around. They were a large, friendly Pakistani family and I was the only one in the flat with footwear on, so I apologised for the intrusion of my boots.

The baby had a history of breath-holding, resulting in periods of apnoea and the hospital had found no cause for it. He was giving his parents regular frights but I reassured them that this was normal for many children and the problem was still not fully understood. The child was wriggling and smiling now, so if there was any danger, it had passed. The mum knew the baby was fine now and she was happy to let me and the crew, who had just arrived, carry on with our shift. Of course, she could call us back any time she felt worried but I knew that the family were going to have to cope with this until the child simply grew out of it.

‘Would you like a cup of tea?’ the child’s father asked as I prepared to leave.

I politely declined. I have yet to enter an ill-mannered Pakistani household.

The night took a bit of a dramatic turn after that. As I headed back to my station and midnight approached, I listened to the voice of another FRU medic as he demanded urgent police assistance. This usually means someone is in trouble or imminent danger. Then he disappeared because the dispatcher on the other end of the radio kept trying to call him back but he didn’t reply. I could hear the tone of the dispatcher’s voice changing as she became more and more concerned. On other shifts I have heard them try to call someone back on the radio and there has been no reply because the FRU medic has left the vehicle after waiting for a response but getting none; I’ve done it myself when on scene. Sometimes you just can’t sit around waiting for them to get back to you. You will hear slight annoyance in the voice of the dispatcher as he or she tries, in vain, to raise someone. This was different though, this was genuine unease.

My radio frequency is set for the Fast Response Units (FRU) only, so every conversation I hear is between Control and a fellow FRU pilot. I sat in the car outside the station waiting, like everyone else who had heard this exchange, to see if the call sign would respond – nothing happened and I imagine the police and an officer or two (and probably the nearest FRU to him) were currently speeding to the scene.

Just as I listened intently for a change in the atmosphere, I received a call for a 25 year-old female who had called her boyfriend up north and told him she was in Regent’s Park after overdosing on pills and alcohol. The information had been relayed to us by the local ambulance service up there and I was being sent to investigate. The message also contained the words ‘pat is violent’.

I tried to get through to Control so that I could clarify the details and get some back-up before I went to this job but they were too busy with the FRU bod who was MIA, so off I went, deciding to be cautious when I got there. I drove through the park and into the inner circle, which is a road that encompasses the park area itself, like a cordon. It was very dark and very, very quiet inside there.

Control called me on my ‘phone and I asked for police back-up. I was told that an ambulance was currently doing a circuit of the outer ring; a road that runs around the perimeter. It would take them a while because that was a long road. I was advised not to approach the woman if I saw her. I didn’t need the warning; I had no intention of going forward in this pitch black place.

As I toured the inner road, using my alley lights to illuminate the pavement and park each side of the car, I spotted an open gate. This was strange because the park is locked up by the police at night. It was almost midnight, so this gate should have been secured with a padlocked chain. As you can see above, it was ajar and almost inviting me to go in. Beyond the gate was nothing but the night and I wasn’t venturing into it. This unstable call had been made by an unstable person and I had no idea what she was capable of – the fact that she was known to be violent was enough to keep me on guard.

I called Control and asked them to direct the crew and police to where I was because I believed that she would have entered the park at this point, if anywhere. Now she could be hidden in the dark somewhere in the vast garden, dead or dying...or simply waiting for some poor fool to happen by.

I waited and watched but nothing stirred. I had no idea what I was going to do if someone appeared from the shadows and walked towards me. I guess I would weigh up the threat and deal with it as it presented itself.

Ten minutes later, the ambulance arrived and we waited for the police, who arrived a few minutes after that. There were three of us just prior to the police arriving, so the crew had gone inside the park using their torches to light the way and I was behind them in another area, using my little alien face torch, with its bright blue light, to see ahead. I don’t have a proper torch and the car isn’t kitted with one (the ambulances are). Every Maglite I’ve ever owned has either failed on me or broken because of the stupid twist-head design of the on-off mechanism. So, I am reduced to carrying a Christmas present. It’s useful but it switches itself off every five seconds, which is frustrating.

The police joined us and we searched and searched. The patrol car drove inside and they used a thermal camera to pick up any heat source. The police helicopter, India 99, was going to be deployed but it was currently busy, so we had to make do. Nothing was found but the park is huge, so it wasn’t going to be that easy.

The girl’s mobile was called again and again by ambulance Control and the police but it went to voicemail. Then, after an hour on scene, the police got through and the girl told them she was at home. An address was given and I was sent to check it out. The ambulance and police were going too.

When I arrived at the address I realised that I knew the street. I had dealt with a suicidal girl here almost a year ago (in fact, I posted it on this blog). She too had called her boyfriend just before taking a load of pills and alcohol. I even remembered the house but the address I was going to was across the street from it.

A police officer met me and, together with his female colleague, we went into a block of flats. We couldn’t find the light switches and had to walk up each flight to the top in total darkness. Given the nature of this call and the fact that we knew her to be violent, this wasn’t helping the atmosphere. I deployed my little blue alien torch and that made us feel a little safer.

Once at the door of the given address, the policeman thumped it hard. A male voice inside called out ‘who is it?’ and several doors started opening around and below us in the building. A Chinese man appeared at the door, he looked bewildered. We knew the suicidal girl’s name, so the police officer asked if she lived there. Of course she didn’t and unless she had a Chinese boyfriend who lived up north, there was no chance she would be in there. It just didn’t look right and the three of us looked at each other with a ‘we’ve been had’ face on.

The other doors had opened to spill out more Chinese men, all of whom seemed concerned about this sudden rude intrusion.

‘Happy New Year’, I said, hoping to diffuse the tension. They smiled, so that was a good start, I reckon.

It turns out they are all working with the Chinese Embassy and this block of flats houses no-one but them, so our mystery girl was lying. I wondered if she was the same person I had taken out of the house, drugged and seriusly ill, across the road last year? When we got back outside, there was a man standing in that very doorway, watching us. How strange. He was asked if he knew the girl but he denied any knowledge of her. Meanwhile the crew had arrived and had heard the commotion inside the building. They had thought the worst and called Control to report it. I then got a call from the FRU desk asking if everyone waas alright and I explained what the noise had been (us inside).

So, we had either been party to a huge and expensive hoax or she was lying in a ditch somewhere having fooled us all into leaving her alone in the park. I didn’t know but two things had a coincidental ring to them. One was that address and the suicidal girl (who had been Chinese, incidentally) from last year and the other was a hoax call I attended at a men’s hostel a few years ago. On that occasion, the call had been made to an ambulance service up north and relayed to us. It was also for a female who was suicidal.

The night rolled on and got busier. Drunken people were now spilling out onto the streets and genuine illnesses were being reported. Then the computer system which conveys calls to us crashed completely. Control could no longer ‘see’ where all the ambulances and fast response units were. Calls couldn’t be sent to our MDT’s and satellite mapping was out the window. Tension was palpable on the voices of the dispatchers as they struggled to gain control over who was where and what was being done. We had to revert to the old system of calling in our status by radio or ‘phone and taking calls ‘manually’; writing it all down and finding our way to the addresses using an A-Z. All very well but I didn’t have an A-Z in the car. There’s never one in it, although there should be and I'll be damned if I can ever find one when I look.

Luckily, I know my way around now, so taking street names was going to be no problem, so long as the calls were in my area. Fortunately, the next call I received was. I was to go and help a 48 year-old drunken man who had collapsed outside a Chinese restaurant. He was completely out of it when I arrived and his friends were worried that they couldn’t rouse him. He responded to deep pain but just wouldn’t wake up. I also found him to be very cold (34.5c) and bradycardic (a pulse rate of 33). This was not good and, unless he had a predisposing medical condition I didn’t know about, he was suffering from hypothermia. But he had only been on the ground for ten minutes, according to those around him, so this sudden hypothermic state was strange.

I called for an ETA on the ambulance but was told there was nothing available. The problem with everything being under the radar is that nobody knew for sure what was available until crews called in. We were also being swamped with resource-draining calls to drunks, fights and falls that needed no more than first aid attention.

After waiting almost half an hour and calling in twice more for help, I decided to treat the man on the street. I’ve done this many times before, especially in the busy summer weekends when waiting for an ambulance becomes the norm. I put fluids up to ‘revive’ the man; the saline would help to wake him up enough for me to safely manage him. The fluid was also fairly warm, having been in my bag in the car all night, so it should also help recover his temperature and heart rate. A blanket was placed under him earlier on because most of the cold would be going through his body directly from the ground, and several blankets were on top of him.

As people left the restaurant, there were looks of disgust and head shakes of shame. Most people can still go out for a meal and a drink without ending up in this state and with the press (and people like me) highlighting the nation’s drunken behaviour, more and more MOPS are looking at inebriated individuals with fresh and disapproving eyes. Soon, with any luck, it will become uncool to get too drunk to walk.

The ambulance arrived after an hour of waiting and the man was still out of it but when my colleague provoked a little pain, he sat up and became a conscious person again. The IV fluid had done the trick. He was helped to the ambulance to warm up and advised to go to hospital but he wasn’t interested, so I removed the cannula from his hand and he was allowed to stagger off with his friend in search of a taxi.

I felt sorry for the Control staff tonight; they were struggling at times to make sense of where everyone was and what they were doing. They were relying solely on the goodwill and honesty of the crews and FRU bods. They weren’t disappointed. Calls were going in regularly as we greened up and made ourselves available. In the end, we are all on the same team and their stress is just as real as ours.

On my way back to the station, I was asked to assist a crew who were dealing with an awkward extrication from a club near Leicester Square. I had heard them on the radio requesting another crew or a Delta Alpha (emergency doctor) to help them out but that was almost an hour ago now and I was shocked to find out they were still stuck with their patient, who had a serious head injury after falling off a balcony and hitting several hard objects on the way to the floor.

I raced to the scene and saw that another crew and FRU were already there but it still wasn’t enough. It took eight of us to get the man upstairs and out of the club. He wasn’t very heavy but he was a little combative at times and the stairs were narrow and winding in places. So, three ambulance crews and two FRU’s were out of action for some time while this one drunken head injury was treated and taken to hospital.

I had a night of strange and sometimes threatening events and we had a system crash but we pulled together and sorted it out, EOC and us (the grunts on the frontline). In the morning as I headed back to base to go home I called in X-ray (which means I am off duty) with no rest break (which means I get to go home 30 minutes early).

‘Thank you very much for all your help’, the radio voice said.

I know she meant it and I felt appreciated for the first time in a while.

Be safe.

Thursday, 7 February 2008

And tonight's illness is...

Eight calls – one declined aid and everyone else went to hospital by ambulance.

The shift started with the first of a run of chest pain calls. Sometimes calls are coincidental all night long - seizures, falls, and chest pains. It's almost as if a committee meets up to decide what type of emergency is going to dominate for the day. 'Let's get all the chest pain calls done tonight' they would say...I imagine.

A sturdy 98 year-old with chest pain actually had muscular pain associated with a strain after she reached down to pick something up. The crew had arrived on scene at the same time, so we went up to the flat together. Her carer told us that she was in some pain earlier in the day but that it got worse every time she moved. She finally gave up after bending over and getting punished for it, so she sat down in her chair and let her carer call us out to check on her condition. We found her to be alert and with good vitals - her only problem was a 'stitch-like' pain in her ribcage. I hope that's all I have to complain about when I'm pushing a hundred.

A call for a 75 year-old male who had fallen in the street, sustaining a hand and leg injury, took me north and out of my area, where I found an incontinent drunken man sitting against a wall being helped by a couple who had been passing by.'We just found him collapsed on the ground. He isn't making any sense and I think he's broken his leg', the male passer-by said, although I felt his handover was a little dramatic. He and his lady friend hovered helplessly over me while I got on with the basics.

‘What’s your name?’ I asked. I used a loud clear voice because the man was wearing at least one hearing aid.

It’s possible the passer-by had mistaken his deafness for confusion. Maybe he thought the old guy was having a stroke. As for his 'broken leg', I couldn't see any evidence of that. The man was in no pain and had no visible problems with his limbs. In any case, how awkward a drunken tumble would he need to have to break his leg so easily? And before you all start shouting osteoporosis, the lack of pain...any pain...led me to believe that he was just sitting down and too drunk to get up. His walking stick was next to him, so he was never steady on his feet sober, never mind in this state.

Nevertheless, cautious as I need to be, I checked what I could for any sign of a change in normal brain function. Alcohol can imitate a stroke and vice versa, so I wasn’t hedging any bets and would wait for the crew to fully assess him in the warm ambulance. The smell, even in the cold night, was beginning to overwhelm me as I crouched close to him.

I thanked the couple for their help, using the standard ambulance service ‘Your help is no longer required and you can go away now’ tone. It usually works first time but for persistent helpful people, it may need to be repeated with a twist.

‘You can get on with your evening now, thank you’, I said diplomatically. It's my version of 'there's nothing to see here'.

The old man reached out to shake their hands and thank them but they didn’t venture to take up the offer, preferring to smile and nod acknowledgement instead.

‘Are you sure I can leave him with you?’, asked the man who thinks everyone has broken their legs after falling.

I know what he meant but the tone had that ‘you don’t look like you can cope alone’ colour to it and I objected inside. Outside I smiled.

‘Of course you can’, I said. I hoped my teeth weren’t clenched. I didn’t want to offend.

After my initial checks I asked him to try and stand up. He managed to get to his feet with a lot of help from me and as I was hoisting him up, a woman stopped and asked if she could help. A very kind gesture, I know, but how much trouble am I in if I look as if I am struggling to lift a 5 foot 5 inch 75 year-old off the ground? I suppose the kind lady was only thinking of my back and I was thinking of hers, so I politely declined and thanked her for the offer. I won’t allow MOPS to help with lifting if I can avoid it – they generally aren’t trained and it’s not worth the potential injury they can sustain. Unfortunately, that’s our job and we cop it if it goes awry.

The crew turned up and took him away after a ten minute wait during which I pinned him to the wall in an effort to keep him on his feet. He was far too drunk to walk anywhere. A straight line would have been a universal challenge. How he got this far from the pub was a mystery. Maybe he flew on the wings of the Red Bull fairy.

My second chest pain call was for a 62 year-old man in a Soho restaurant. He had just started his meal with a gang of work colleagues when a shooting pain cut across his chest, sternum to axilla. He had suffered this type of pain before but had been cleared by the hospital of any cardiac problems. It looked like he had experienced a transient muscular problem because by the time I arrived, which was a mere three minutes after the call was made, he had completely recovered.

The crew arrived a few minutes after me and he was taken to the ambulance for an ECG. This showed an irregular heartbeat, which in itself can mean nothing but in conjunction with chest pain and his recent history, it was worth further investigation, regardless of his previous check up. The paramedic offered to take him to hospital but he declined. 'I think I'll pass', he said. I think he was scared but he was taking a bit of a risk with his health.

It's worth noting that he had just finished his starter and if you are going to pay London prices to eat out, you best get chest pain after the meal has been completely eaten. Maybe that’s why he declined and went back into the restaurant. As a Scot, I can see his point of view.

This call was followed swiftly by another chest pain. A 47 year-old man developed crushing central chest pain whilst playing bridge with his friends. Again, the crew were with me on scene and again, the man's pain had subsided by the time we arrived. He looked well enough but his friends confirmed that he had become very pale and sweaty when the pain struck. He had no cardiac history, just high blood pressure, but he had been taken to hospital before for chest pain - nothing had been found. This would be his second trip for the same problem.

Chest pain again...a 36 year-old woman with no previous cardiac history and a clean bill of health was lying on her sofa, husband at her side, when I went into her flat. She explained how the pain had been with her all day. She pointed mainly to her upper abdomen and told me she had taken Gaviscon but this hadn't worked (people often mistake cardiac pain for indigestion). Whether or not this was simply a gastric problem remained to be seen but her colour and demeanour suggested it probably was. She had no breathing problems and she was able to move without too much discomfort.

The crew arrived as I got on with my obs and she was taken to hospital once I had completed them.

Bending over to pick something up provoked yet another 999 chest pain call. I arrived at the little basement flat after cautiously entering the building in the dead of night. I had received an alert on my screen which stated that this was a 'high risk address'. I contacted Control to establish whether it was or not and I was told that the information was inaccurate, so I pressed on but when I got there the place was a bit dodgy looking and the basement flat across from my patient's looked like a drug den – metal shutter over the door glass, damaged locks...that sort of thing. At first I thought this was the flat I was to enter but my patient’s was across the hall.

The door was ajar and I could hear nothing inside, so I knocked and waited for a voice. I always assess the threat by the tone of the answering voice; if it is male or sounds edgy, I will go very slowly. If it is female (and I know this smacks of sexism but I am playing the odds) and sounds even, then I am more confident about entering. Either way, I will always leave the front door open and look around for other people inside. Sounds paranoid, I know, but it has kept me safe so far.

‘In here’, the even-sounding female voice shouted.

The 46 year-old woman inside had bent over to pick something up when she felt something tighten across her chest. At first she described it as feeling a ‘crack’, like a muscle had gone but then, as I examined her, she gave a more accurate description. Her heart was racing; she was tachy at around 220 bpm. Then her pulse slowed right down to 36 bpm – quite a dramatic change in tempo. She was understandably anxious about this and I was concerned that her heart could become unstable and the rhythm would convert to something more dangerous, like VF. I was pretty sure she was suffering from paroxysmal atrial tachycardia (PAT) but without a proper 12 lead ECG, I couldn’t confirm anything.

The crew arrived when I had finished my basic obs and her heart rate had stabilised and was back to normal, although she still had a niggling pain in her neck. I handed over and she was taken to hospital. Her ECG had looked fairly normal but then, without the physical manifestation of PAT, there would be little or no evidence of it on the strip anyway. We had to catch it while it was there.

Three hours passed in the early hours and the 999 ocean was calm. In between hoax calls (yes, our regular nutcase is still making them – three tonight) which were cancelled before I moved, I managed to get some rest. I think we were short on ambulances tonight because I had been running out of area frequently.

As the nightclubs started throwing people out, I received a call for a 20 year-old female with a head injury after a fall. Her heavily bloodied and almost hysterical body was walked over to the car by a group of people, including a police officer, as soon as I arrived. The waving from the windmills had been frantic enough to alert me to the possibility that she wasn't just another drunken woman who had toppled over, courtesy of alcohol. She wasn't too drunk at all, in fact

Her head had been covered in a dressing which was placed by the club's first aider but there was a lot of blood coming from an area to the back of her skull which had not been covered properly. Instead, the poor first aider was pressing blue paper towel into it to stem the flow. This was sticking to her hair and the congealed stuff when I removed it to have a look. Unfortunately, the lack of good light meant I couldn't see where the blood was coming from, so I wrapped another dressing around the area in the hope that I was on target.

Meanwhile, the young girl was sobbing and rocking back and forth, wondering what had happened to her world. Apparently she was dancing on a bench seat inside the club, lost her balance and landed on the uncovered concrete floor, using her head to break her fall. I went in to see the place when the crew arrived and took her off my hands. Apart from the video screens and the bar, the place was pretty Spartan and looked like it had been put together with only one thing in mind - profit. Certainly not comfort. Hard seating and hard flooring is hardly empathetic to human bones.

She may have been knocked out because she couldn't remember what happened and this seemed to upset her even more. The female crew had a calming effect on her though and by the time she was driven off, the crying had stopped and was replaced by quiet resignation and the odd sob.

I raced off to my next (and last) call an hour before I was due to go home. It was for an 83 year-old lady who had fallen and hurt her ribs. The crew were on scene and decamping from their ambulance and the old lady walked herself out to meet them, so I wasn’t required. I set off for my base station but got diverted to a call over four miles away – well out of my area. I queried it but got a stern response. Yes, I was the nearest vehicle to it. Sometimes you get made to feel guilty just for wanting to get home on time.

I sped off and got within two streets of the call when I was cancelled down. Great. If it wasn’t for the light traffic, I would have been late getting back but I managed to ‘clock out’ on time.

If I am to face a busy, drunken Thursday night then I will need a decent sleep. That’s fair, isn’t it?

Be safe.